Chikungunya and Children: What Rising Global Cases Mean for US Families

As global cases of chikungunya rise, especially in regions such as the Southern Hemisphere and China, clinicians in the US are keeping watch, particularly when it comes to pediatric patients. While domestic transmission remains unlikely, travel-related cases are expected to continue.

Sharon Nachman, MD, division chief for pediatric infectious disease at Stony Brook Children’s Hospital, explained that chikungunya is spread exclusively through mosquitoes, not from person to person. “The virus, or chikungunya, is carried by mosquitoes. It does not transmit person to person,” Nachman said. “A lot of the concerns we've had with other viruses—being in a crowd and passing it from one to the other—are not there for chikungunya because it's passed by mosquitoes. You have to be in an area that these mosquitoes live.”

Currently, the mosquito species responsible for chikungunya transmission is not found in the northern United States. “We're not seeing it in the northern United States because that mosquito that carries that virus, and that virus, are not here,” she said. “The cases that we see in New York are not native to New York, but rather people who traveled.”

Vaccines are available but not universally recommended. “There are two preventative vaccines,” Nachman explained. “One is a live attenuated vaccine, which means that you can't take it if you have any underlying immune issues, if you're older, etc. The second one is not a live vaccine, and anyone can take it over age 12. But we don't want to give it out if we don't need to give it out.”

The recommendation to vaccinate depends largely on travel plans. “If you're going to live in a country that has lots of chikungunya for at least a month, we'd recommend the vaccine. But if you're going, for example, to the Dominican Republic for just a quick vacation, that's not someone who we recommend a vaccine for.”

For children, symptoms tend to be nonspecific, including fever, fatigue, and body aches. “Kids, just like adults, can easily get infected. And of course, you can imagine—kids to mosquitoes—they taste delicious, and mosquitoes always find our children,” she said. “The kids present with fever, feeling poorly, muscle aches and joint aches. They won’t have a rash. And the most important thing we'll hear from them is that they recently traveled.”

If there's no recent travel, testing for chikungunya is not typically pursued. Although, Nachman stated, “if you said to me, ‘My family just got back from the southern hemisphere a few days ago, and now my kid is having fever and they feel terrible,’ but really not having respiratory symptoms, more like body aches and fatigue and fever, I would say you're probably going to be having a mosquito-infected disease called chikungunya.” Treatment is supportive only: “Rest, Tylenol, Motrin, chicken soup—those things really work—and you have to wait it out.”

Preventing mosquito exposure remains the key strategy. “The advice we give to families, not just for chikungunya, but for all the mosquito vector pathogens, is: don't let the mosquitoes breed in your backyard,” Nachman said. This includes eliminating standing water, staying indoors at dusk, and using DEET-based repellents. “If you see standing water, dump it out. Don’t leave water in flower pots or in the, you know, containers, because that is a wonderful place for the mosquitoes to breed.”

For families planning international travel, she recommends discussing destination-specific risks with a healthcare provider. “Knowing who you are and where you're traveling and for how long you're going to be there will help you and your physician decide what medications or other things you need to do before you go.”